56. Making the Co-op a bit more Hendrix.

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An early attempt at the anatomy pop-up book.

Almost every medical problem in some way boils down to a faulty feedback cycle. The simplest examples are endocrine diseases like diabetes, but the model can be applied to cancer cells, where cell division fails to switch off, and immune diseases, where antibodies mistakenly attack a person’s own tissue. A lot of economic or political debate falls into this same category of trying to fine-tune a system. For instance, using higher interest rates to reduce borrowing, or tougher sentences to reduce crime. Sometimes a system breaks down, failing to respond to feedback, like the heating systems on East Midlands Trains, which have fallen victim to the fashion for Hot Yoga.

Today, we learn that the Co-operative Group is ungovernable. That seems like an over-reaction, based on my experiences at the local Co-op supermarket. But when I think about it more carefully, the signs have been there for a while. Firstly, the car parking spaces went from impossibly narrow to Humvee size. Then there were the yellow sticker reductions – from £2.99  to £2.97. Not enough action there to clear a pile of steak pies facing a tight sell-by date. And when the pet food and pet product aisle became longer than the people food section (I accept there’s an overlap), we should have seen the writing on the wall. As well as the actual writing on the wall, which says ‘Laura H is Easy’.

During its flirtation with electricity, Psychology showed an interest in Biofeedback. This was an attempt to exert conscious control over a supposedly unconscious function, like blood pressure or heart rate. To learn this, a person needed a machine that would continually measure and reveal the reading concerned, and a system of relaxation. You can still buy biofeedback machines, but they are competing with tablets like beta blockers that don’t need plugging in. There could be a biofeedback revival once access to Functional MRI gets easier, for instance if you can get one on your android phone. For Apple you’d need the £25 adaptor.

I just got back some feedback on myself, from colleagues and patients, in the form of a so-called 360 degree assessment. We have to do one every five years. It seems like a slow process, but that’s about 20 times more frequent than the Cooperative Society. Alleged ‘crystal methodist’ and adult-content-consumer Paul Flowers, who chaired the co-op bank until last year, apparently did very well in aptitude and psychometric tests prior to his appointment in 2010. I suspect he’d have passed his 360 with flying colours too. Flowers was said for instance to have been excellent at engaging other people’s views. History may yet regard him as a great chairman. If he’d worked in the NHS he’d have been reinstated by now in a different branch at twice the salary.

To make feedback work we need to make the sampling frequency higher and the amplitude lower – a process that cuts in as soon as someone goes ‘off message’. Something more akin to the kind of feedback Jimi Hendrix achieved in his version of Star Spangled Banner. Imagine a system for instance that connects a politician or corporate giant to a brain imaging device. This could display his brain activity as he goes along, either to himself on an autocue, or to the audience, on a powerpoint display. Similar techniques have been applied to audience feedback during political speeches and even movies, using appreciation buttons.

Amazon apparently know which are the best pages in novels, based on how quickly they are read. Imagine what the great novelists could have done with this technology. Maybe it would have stopped characters suddenly dropping dead from a chill, or selling their wife at a market. Or making Laura H, suddenly, ‘difficult’.

It’s said that people who become habitual liars fail to notice whether they are even lying or not and even come to believe their own lies. Yet lie detectors have been around for decades. We already have a host of biological measurements such as EEG and skin conductance. We already have heads up interactive displays such as Google Glass. We already have portable electric shock devices. And somewhere in the world there is probably a large pile of testicle electrodes. Surely it won’t be long before someone connects up these technologies?

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8. The age of Sprocket Man.

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Is the modern world inherently toxic to our bodily systems? Niall Ferguson included Work Ethic as a killer app for society. It is certainly a killer, but in a more literal sense.

The body uses countless timing devices to regulate itself. Obvious examples are the night and day cycle, the heartbeat and brain waves.

Systems theory teaches us that everything has a point of equilibrium or natural balance. Most things have a natural frequency at which they like to vibrate. Some cars like to cruise at 50 mph, some like to cruise at 90 mph. Generally, the more German the car, the faster it likes to go.

Many systems have a feedback mechanism of some kind that puts them back to their default setting. On the road system, large potholes have been left like landmines to deter overenthusiastic driving.  Inspired by the ‘safety car’ concept in Formula 1, our government has paid an army of older gentlemen to drive at a constant 42mph all over the country, to keep speeds down. As a uniform, they wear trilby hats. These are only worn when actually driving at 42 and never outside the car.

Farmers have received grants from the EU to bring their otherwise redundant farm machinery out onto the major highways at peak times, similarly to check undue haste.

In our neighbourhood we have learned to beware a vehicle we call ‘the Stealth Renault’. Painted black, this innocuous 1980s model is driven by an extremely old person (or a person disguised that way), in second gear at a constant 30 mph. His trick is to give you the impression that he will stop or is stopping at your pedestrian crossing.

He never stops though. Like Sandra Bullock in Speed, he maybe believes a bomb will go off if he drops to 29.

He is a road safety bogey man. He never ratified the green cross code. He is there to teach children never completely to trust traffic lights. He may in fact be a dummy, the car actually being driven by remote control from a university psychology lab, as part of a learned helplessness experiment. Or maybe by the authorities, to keep us a little on our toes.

After all, we may be getting a bit complacent. Such close encounters with terrorists like Stealth Renault are relatively rare nowadays. It is surprising how routine most activities have become. The post office queue stands patiently, First Capital Connect arrives on time, the Sky box records your favourite programs. I appreciate that other societies and parts of the world are different, but the UK, with the possible exception of Doncaster, has adopted a ‘no drama’ policy.

Isaac Newton taught us that every action is met by an equal and opposite reaction. Every time I turn the heating control down another person will come and turn it up to a point slightly higher than it started originally. The body has a similar system in the hypothalamus, which can be used if thermal underwear is not available.

In larger systems, such as the NHS, an attempt to make a change will be resisted with significant force. Employees in large organisations tend to work like small cogs in a gearing system. If the small cog gets out of line the whole gearing system will crush it back into place, a few splines missing, but still turning.

A lot of ‘choice architecture’ is set up this way, large systems with high moment of inertia. Franchised models and low variance operating schedules ensure you will find the same shops and restaurants in every town.

Why not put the Hugo Chavez T shirt away and just coast along with things? People are living longer after all, and the television screens are getting bigger, sharper and cheaper all the time.

Why is it then that so many people seem to be unhappy? A recent survey by Unicef suggested that children in the UK are among the unhappiest people anywhere.

‘Pressured and commercially vulnerable, our kids are the most miserable in the industrialised world’ spoke the Guardian. People have blamed a mixture of possible causes, from inequality to the demise of the nuclear family.

Blur titled an album ‘Modern Life is Rubbish’ and I find myself quoting that to people whenever there is a spectacular system failure, such as getting stuck in a 20 mile traffic queue, or trying to pay for parking using a mobile phone.

Another line I find myself saying is ‘everything is relative’. There are many compensations in modern life.
It is the best time ever for ease of communication. Even Captain Kirk did not have a smartphone.

Food is at once the best and the worst it has ever been, depending on whether and how you choose your ingredients. I went to the Turkish part of London yesterday and had an amazing breakfast for £5.

A car made in 2013 is undoubtedly, objectively and measurably superior to a car made in any earlier period. It is faster, stronger, safer and more economical than before, and it is never mustard or beige coloured.

This is probably not the best period for music composing, which peaked in the classical period. But it is the best time for listening to Beethoven or Mozart, or any other music, because we have fabulous sound quality in concert halls and from hi-fi systems.

The best novels ever were probably written in the nineteenth century. But we can read them all free now on a device that weighs half a pound.

The renaissance period gets the prizes for painting and sculpture. But they did not have antibiotics or dentistry.

Teaching was probably better 50 years ago than it is now. And, as we know, History ended in 1989.

Different systems peak at different times. It s hardly likely that all systems will peak at the same time. That’s having your cake and eating it; or finding the M25 is completely clear all the way round.

If you happen to be lucky your system suits your natural frequency, and you will run smoothly. Your system will mesh with other systems and you will spin freely on your bearings.

If you are unlucky, like most UK children apparently, you are not in tune with your system.

For instance we know that children function better if they start school at 10 or 11 am, but our local school makes them start at 8am. The problem for children is that their system runs subordinately to every other system, so that they are made to fit in with adults rather than the other way round. The more your system is subordinated to others the less chance you will be in your own element.

The advancement of the system devoted to economic productivity has marginalised children, along with the old and sick, to the bus replacement services of life.

Children cannot vote, after all. They are just lucky that they don’t have to sweep chimneys any more. Worse than chimneys though, we have breakfast club and afternoon club, not to mention the dreaded school bit in between the clubs.

David Cameron said today that he wanted to place himself on the side ‘of hard working people who want to get on in life’.

What about those people who yearn for a life of recreation and entertainment? Shouldn’t all those machines and mechanised systems have made it possible not to work so much?

A big category of mental health diagnoses is the so called Adjustment Disorders. These come in various forms, including depression and anxiety. They are usually mild and transitory and reflect what many people loosely refer to as stress.

They can be seen as a wrench caused by a change of system, much like ‘frozen points at Guildford’ delayed Reggie Perrin by 11 minutes each morning. If frozen points cause a complete derailment, then the Adjustment Disorder is upgraded to a more serious diagnosis like Depressive Episode. A lot of depressive episodes also seem to follow adverse, or even positive, life events, which have caused a crunching in the gears.

The concept of mental health problems being stress related is attractive and easy to understand. But it only tells a part of the story. Most people are robust when it comes to negotiating changes.

Perhaps they have a wider tolerance to a range of operating conditions, so they are more often in their comfort zone.

A comfort zone is supposed to be a behavioural state where we are happy and confident and working reasonably well.

Some people work on their comfort zone more actively than others. Attributed to golfer Gary Player is the phrase: ‘the harder I practice the luckier I get’. Specifically referring to shots played out of sand, Player mastered the shot to the extent that he was equally comfortable in the bunker as on the grass.

Round about the time Player made that quote, in the sixties, psychologists developed the theory of Learned Helplessness.

Psychology nowadays keeps a bit quiet about these sorts of experiments -suffice it to mention the words electric shocks and dogs.

Later on, with the move from behaviourism to ‘cognitivism’, the negative effects of helplessness turned out to be more to do with a person’s pessimistic explanatory style than the actual experience of not being in control. This led to the idea of hopelessness, and the relationship of that state to suicidal thinking.

The issue is not so much whether we really have control over what happens to us, but more whether we think we do.

Studies in Ireland have shown that patients with Depression like their therapist to take an upbeat and optimistic stance with regard to whether and how much recovery will take place.

I remember a moment when, as junior doctors, we observed the arrival of a very senior colleague, in a severely dilapidated Ford Escort. It was trendy at the time for the psychotherapy – orientated type of psychiatrist to drive ‘crap cars’, such as this one or the Austin Maxi (mustard colour). As we watched, another SHO colleague put this scenario to me:

‘Imagine you’re in the depths of despair. You have been tried on every type of antidepressant. You’ve tried counselling and psychotherapy. You’ve had herbal medicines and homeopathy and transcendental meditation. The GP finally arranges a visit from the leading specialist at the teaching hospital. You watch through the window, and you see in the distance the Professor arrive in his Escort, which has large furry dice dangling from the mirror. Is that not the moment when suicide seems inevitable?’

Harsh perhaps. Equally, people might like to see someone eminent arrive in a non pompous vehicle like a 2CV covered in stickers or an original Beetle with vase. I can’t remember any specific training on what vehicle to drive, although an older colleague insisted that consultants should only ever have Michelin tyres, ‘never Goodyear my boy’.

To return to the point, the feeling of having a choice matters a lot, even if in the wider scheme of things, the biggest choice we really get is between Diet Pepsi and Pepsi.

The comfort zone is largely a place where we choose what happens to us. A lot of people want to move us out of our comfort zone.

It’s true that we will be more productive if we are challenged just a little. Coaches know that a mixture of support and challenge can bring about superior achievement. The same approach can work well in therapy, for instance treating a phobia. If the comfort zone has got too narrow then it needs to be carefully increased.

Unfortunately, in most organisations, the challenge is greater than the support. The pressure is always on to squeeze a little more out of the system. Supermarkets want to get the milk off the farmer for a few pennies less. The farmer turns the cows up to 11, giving them more food, or playing them some Led Zeppelin at milking time.

The effect of the larger and more dominant system on your system is felt as disharmony, or being slightly behind the beat, or as a little ping in the ears. Your system might be different.

Interestingly, this is exactly the kind of disorientated feeling that makes us purchase something – retail therapy – or consume some alcohol – drug therapy. The work ethic is all about ‘must’ ‘should’ and ‘ought to’.

It all depends whether we want to make superior achievements or just be happy with what we have. It’s not a choice we seem to get very often. Even the illusion of choice is worth a lot though. Turkish breakfast. Mozart. Thomas Hardy. And, today I think, Diet Pepsi.

The comfort zone is equivalent to driving at 50mph.

It’s better than 42. It might even be better than 52.

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PS: It looks a bit like this one.